Joint replacement restores mobility minus the pain

January 12, 2013

Today’s advanced generation of joint replacement surgery is helping millions of patients return to active, pain-free living.

Today’s advanced generation of joint replacement surgery is helping millions of patients return to active, pain-free living.

Thailand’s population is aging as lifespans grow longer. But greater longevity doesn’t necessarily mean that seniors are enjoying a better quality of life. Declining bone and joint health remains a significant threat to senior mobility and a good life quality.
The good news is, advances in joint replacement surgery are helping a growing number of patients with joint problems return to active living free from debilitating pain. To learn more about the procedure, Better Health turned to two of Thailand’s leading joint replacement surgeons – Dr. Siripong Ratanachai, Director of Bumrungrad’s Joint Replacement Center, and Dr. Keerati Charoencholvanich, an orthopaedic surgeon at the center.


Is joint replacement surgery common in Thailand?

Dr. Keerati:  While the government doesn’t compile national statistics on the procedure, at Bumrungrad alone hundreds of patients have joint replacement surgery every year. Urban and rural people tend to present different joint problems requiring different treatments. People from rural areas have a higher incidence of hip replacement, while those from urban areas have more knee replacements.


What are the main factors that necessitate a joint be replacement?

Dr. Siripong:  Osteoarthritis is one of the leading factors among urban patients. It’s a degenerative joint disorder caused by wear and tear and the long-term impact on weight-bearing joints from being overweight or obese.
Patients from rural areas typically come with problems affecting their joint ligaments, bursae or tendons, and many also have a co-existing condition such as diabetes, arthritis, rheumatoid arthritis, or SLE, to name a few.


What’s the connection between these diseases and damage to joints?

Dr. Keerati:  Diabetes and other chronic diseases can reduce blood flow to the hips and other joints. This can be made worse by unhealthy habits such as excessive alcohol consumption or the use of herbal remedies containing steroids – something that’s becoming more prevalent in many countries.
Adding to Dr. Siripong’s point on lifestyle habits, sitting on the floor and using squatting-style toilets are more common among rural Thais. These habits tend to place greater stress on knees by a factor of three to five times.


How do doctors determine whether a joint should be replaced? 

Dr. Siripong:  Deciding on joint replacement surgery is a collaborative process that should include the doc-tor, the patient and the patient’s family. The patient may be referred to an orthopaedic surgeon for a thorough evaluation and assessment.
If treatments such as non-steroidal anti-inflammatory drugs, cortisone injections, and/or physical therapy don’t achieve sufficient improvement, and the patient’s daily activities are impacted by pain and reduced mobility, then the patient is probably a good candidate for joint replacement.


The idea of surgery worries some people. What should they know about joint replacement surgery?

Dr. Keerati:  Today’s generation of joint replacement surgeries is much improved over earlier types of major invasive procedures that required significant tissue loss and longer recovery periods. Advances in surgical techniques have greatly reduced the risks associated with joint replacement surgery, and Thailand offers the latest technologies and surgical techniques.
Doctors consider total joint replacement only after non-surgical treatments don’t achieve the desired results. These methods include exercise, walking aids, medication, and other treatments.
When the damage to a knee is less extensive, for example, doctors may consider replacing just the damaged parts of the joint, a procedure known as partial joint replacement. This typically involves replacing the inner or outer knee surfaces, depending on the specific nature of the damage.
In cases of severe joint damage, such as when a joint deformity limits joint movement and causes severe pain even while the patient is resting, total joint replacement may be necessary.
Younger patients in their 40s or 50s who show early signs of joint damage may prompt doctors to consider surgical re-alignment of the affected joint as well as partial joint replacement. The complete replacement of the joint would be considered as a last resort.


Under what circumstances would joint replacement surgery not be recommended despite severe joint damage?

Dr. Siripong:  The doctor’s assessment of the patient’s candidacy for joint replacement surgery boils down to whether the patient would likely benefit fully from the procedure while being unlikely to suffer complications. Doctors are unlikely to recommend joint replacement for patients who have muscle weakness or paralysis, and those lacking sufficient muscle control due to traumatic injury, serious infection or a neurodegenerative disease such as multiple sclerosis or myasthenia gravis – even though their joints show significant wear and tear.
The second group includes patients who remain pain-free despite significant joint damage and continue to enjoy a good quality of life.


How long do artificial joints typically last?

Dr. Siripong:  On average, an artificial joint has a lifespan of 10 to 20 years. This is one reason why joint replacement is most often recommended for people over 60.

Artificial joint lifespans can vary due to one or more factors: the surgeon’s ability to accurately align the new joint device, extensive wear and tear among more active patients after surgery, and the quality of the chosen artificial joint. Dealing with the three factors in an optimal way translates to a 95 percent chance of the artificial joint lasting beyond 10 years, and an 80 percent chance of lasting more than 20 years.


Since the procedure involves many advanced technologies, has the doctor’s role become less important?

Dr. Siripong:  The doctor still has the leading role in the procedure, while the various technologies take on supporting roles. Surgery isn’t a starting point for treating damaged joints; doctors specializing in orthopaedics begin helping patients well before any surgical procedures might be recommended. Doctors must determine the right time for replacement surgery after concluding the procedure will not endanger the patient’s health nor greatly increase the patient’s risk level.
Dr. Keerati:  A successful surgery is one that offers a high degree of safety and produces the desired result. Doctors must first make a proper determination that the patient is a good candidate and meets the health guidelines specific to the procedure.
That’s followed by the doctor’s surgical capabilities, especially his or her ability to correctly align the joint while keeping damage to surrounding tissue minimal.
The doctor’s experience and expertise are also tested when choosing the specific artificial device to ensure it delivers the optimal fit.


Why do some patients need to undergo a second joint replacement surgery?

Dr. Keerati:  We often say “the first is always the best.” A second surgery is sometimes necessary, but when it's done right the first time, there’s less of a chance you’ll need a second surgery. 
Dr. Siripong:  Nowadays about 20 percent of the patients who had the earlier generation joint replacement surgery return for a second surgery. Sometimes this is due to the device reaching the natural end of its lifespan, while other patients’ replacement joints have worn out early due to the previous surgery being less accurate, causing the artificial joint to wear out faster.
Dr. Keerati:  One thing that’s important to mention: Many patients enjoy good results from the surgery, and return to their normal lives, but never come back for follow-up visits with their doctor. Seven or eight years later, they return needing a second surgery. It’s very important after the surgery to see your doctor regularly – at least once a year. One reason is that specific parts of the artificial joint may wear out sooner but can be repaired easily with minimal effort, and without requiring replacement of the entire artificial joint.


What should a patient do to prepare for joint replacement surgery?

Dr. Keerati:  Patients need to prepare both body and mind. ‘Body’ basically means one’s physical health. Patients should continue with periodic health check-ups and make sure any chronic diseases are being properly managed and remain under control.
Mental health and well-being is also important. People tend to be afraid of the unknown. The best way to counter that is to learn about the planned procedure through research and by asking your doctor about your specific condition and the various treatment options. Once you understand your situation, things are no longer unfamiliar, and you’ll have less anxiety.
Dr. Siripong:  It’s our duty to inform patients and their families about the patient’s current situation, explain what we’re hoping to accomplish and how we will accomplish the goal, and why we’re making a specific recommendation. This helps create mutual understanding, boosts confidence and fosters cooperation between doctor and patient.

“The doctor still has the leading role in the procedure, while the various technologies 

take on supporting roles.”  
Dr. Siripong Ratanachai

Robotic joint replacement surgeries

Many advanced joint replacement procedures now employ robotic arm technology that delivers even higher levels of precision and accuracy in the alignment and placement of artificial implants. “This is very exciting technology,” says Dr. Siripong. “It allows orthopaedic surgeons to achieve more precise and more accurate joint placement and alignment, which results in even better surgical outcomes.”
Robotic arm systems provide surgeons with pre-surgical plans outlining bone preparation techniques and custom-tailored positioning of implants using a CT scan of the diseased joint. “During the procedure, the system creates a three-dimensional live-action virtual view of the bone surfaces while correlating the image to the surgical plan,” says Dr. Siripong. “Then, using a small incision, the surgeon engages the robotic arm to begin preparing the damaged joint for replacement with minimal impact to surrounding healthy tissues. The technology enables more precise implant positioning and placement for each individual patient. As a result, patients typically resume walking in the first 24 hours after surgery.”
Dr. Siripong believes that, in the not-too-distant future, joint replacement surgery will evolve thanks to further technological improvements and more experience gained by orthopaedic medical professionals. “Artificial joints can’t compare with the real joints we’re born with,” he explains. “So we should take good care of our health and try to avoid activities that damage joints.
“Joint replacement surgery should be the last option to consider after other treatments are unable to restore a patient’s good quality of life,” Dr. Siripong says. “If you decide to have joint replacement surgery, take steps to help make it right the first time. Do some researches, talk to your doctor, ask questions, and be sure to follow your doctor’s advice.”

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